Added value of  68 Ga-PSMA PET/CT for the detection of bone metastases in patients with newly diagnosed prostate cancer and a previous  99m Tc bone scintigraphy

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Abstract

Purpose

To investigate the added value and diagnostic accuracy of ⁶⁸Ga-PSMA PET/CT versus bone scintigraphy (BS) for bone metastasis detection at the primary staging of prostate cancer (PCa).

Methods

Inclusion criteria involved consecutive patients with newly diagnosed intermediate- to high-risk PCa, who had undergone BS, mostly with supplementary SPECT/low-dose CT, and ⁶⁸Ga-PSMA-11 PET/CT within less than 3 months without therapy initiation between the two investigations. BS was evaluated according to clinical routine and reported as no bone metastases (M0), bone metastases (M1), or equivocal (Me). The ⁶⁸Ga-PSMA-11 PET/CT was blindly evaluated by three specialists as M0, M1, or Me at the patient level. Sensitivity analyses were conducted using a “best valuable comparator” using all available imaging and clinical follow-up as a reference.

Results

In total, 112 patients were included; ⁶⁸Ga-PSMA-11 PET/CT showed a sensitivity of 1.00, specificity of 0.93–0.96, positive predictive value of 0.74–0.81, and negative predictive value of 1.00. ⁶⁸Ga-PSMA-11 PET/CT revealed bone metastases in 8 of 81 patients with M0 disease according to BS. ⁶⁸Ga-PSMA-11 PET/CT confirmed the presence of bone metastases in all patients ( n = 9) with M1 disease according to BS. In patients with Me by BS, ⁶⁸Ga-PSMA PET/CT provided a definite result in 20 of 22 patients. ⁶⁸Ga-PSMA-11 PET/CT resulted in a false-positive answer in four patients with solitary rib lesions.

Conclusion

⁶⁸Ga-PSMA-11 PET/CT revealed bone metastases in 10% of patients without bone metastases on BS and in 36% patients with indeterminate BS. However, solitary PSMA-avid lesions in the ribs should be interpreted cautiously as they may represent false-positive findings.

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Most cited references 12

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Impact of long-term androgen deprivation therapy on PSMA ligand PET/CT in patients with castration-sensitive prostate cancer

Ali Afshar-Oromieh, Nils P Debus, Monika Uhrig … (2018)

Purpose Since the introduction of PSMA PET/CT with 68Ga-PSMA-11, this modality for imaging prostate cancer (PC) has spread worldwide. Preclinical studies have demonstrated that short-term androgen deprivation therapy (ADT) can significantly increase PSMA expression on PC cells. Additionally, retrospective clinical data in large patient cohorts suggest a positive association between ongoing ADT and a pathological PSMA PET/CT scan. The present evaluation was conducted to further analyse the influence of long-term ADT on PSMA PET/CT findings. Methods A retrospective analysis was performed of all 1,704 patients who underwent a 68Ga-PSMA-11 PET/CT scan at our institution from 2011 to 2017 to detect PC. Of 306 patients scanned at least twice, 10 had started and continued ADT with a continuous clinical response between the two PSMA PET/CT scans. These ten patients were included in the current analysis which compared the tracer uptake intensity and volume of PC lesions on PSMA PET/CT before and during ongoing ADT. Results Overall, 31 PC lesions were visible in all ten patients before initiation of ADT. However, during ongoing ADT (duration 42–369 days, median 230 days), only 14 lesions were visible in eight of the ten patients. The average tracer uptake values decreased in 71% and increased in 12.9% of the PC lesions. Of all lesions, 33.3% were still visible in six patients with a complete PSA response (≤0.1 ng/ml). Conclusion Continuous long-term ADT significantly reduces the visibility of castration-sensitive PC on PSMA PET/CT. If the objective is visualization of the maximum possible extent of disease, we recommend referring patients for PSMA PET/CT before starting ADT.

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68Ga-PSMA-11 PET/CT Interobserver Agreement for Prostate Cancer Assessments: An International Multicenter Prospective Study

Wolfgang Peter Fendler, Jérémie Calais, Martin Allen-Auerbach … (2017)

The interobserver agreement for 68Ga-PSMA-11 PET/CT study interpretations in patients with prostate cancer is unknown. Methods:68Ga-PSMA-11 PET/CT was performed in 50 patients with prostate cancer for biochemical recurrence (n = 25), primary diagnosis (n = 10), biochemical persistence after primary therapy (n = 5), or staging of known metastatic disease (n = 10). Images were reviewed by 16 observers who used a standardized approach for interpretation of local (T), nodal (N), bone (Mb), or visceral (Mc) involvement. Observers were classified as having a low ( 300 studies; n = 6). Histopathology (n = 25, 50%), post-external-beam radiation therapy prostate-specific antigen response (n = 15, 30%), or follow-up PET/CT (n = 10, 20%) served as a standard of reference. Observer groups were compared by overall agreement (% patients matching the standard of reference) and Fleiss' κ with mean and corresponding 95% confidence interval (CI). Results: Agreement among all observers was substantial for T (κ = 0.62; 95% CI, 0.59-0.64) and N (κ = 0.74; 95% CI, 0.71-0.76) staging and almost perfect for Mb (κ = 0.88; 95% CI, 0.86-0.91) staging. Level of experience positively correlated with agreement for T (κ = 0.73/0.66/0.50 for high/intermediate/low experience, respectively), N (κ = 0.80/0.76/0.64, respectively), and Mc staging (κ = 0.61/0.46/0.36, respectively). Interobserver agreement for Mb was almost perfect irrespective of prior experience (κ = 0.87/0.91/0.88, respectively). Observers with low experience, when compared with intermediate and high experience, demonstrated significantly lower median overall agreement (54% vs. 66% and 76%, P = 0.041) and specificity for T staging (73% vs. 88% and 93%, P = 0.032). Conclusion: The interpretation of 68Ga-PSMA-11 PET/CT for prostate cancer staging is highly consistent among observers with high levels of experience, especially for nodal and bone assessments. Initial training on at least 30 patient cases is recommended to ensure acceptable performance.

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68Ga-PSMA PET/CT Replacing Bone Scan in the Initial Staging of Skeletal Metastasis in Prostate Cancer: A Fait Accompli?

Thabo Lengana, Gbenga O. Popoola, Kgomotso M.G. Mokoala … (2018)

68Ga ligands targeting prostate-specific membrane antigen (PSMA) are rapidly emerging as a significant step forward in the management of prostate cancer. PSMA is a type II transmembrane protein with high expression in prostate carcinoma cells. We prospectively evaluated the use of 68Ga-PSMA positron emission tomography/computed tomography (PET/CT) in patients with prostate cancer and compared the results to those for technetium-99m (99mTc)-10-metacyloyloxydecyl dihydrogen phosphate (MDP) bone scintigraphy (BS).

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Author and article information

Contributors

Helle D. Zacho:

ORCID: https://orcid.org/0000-0001-9089-288X

h.zacho@rn.dk

Journal

Journal ID (nlm-ta): EJNMMI Res

Journal ID (iso-abbrev): EJNMMI Res

Title: EJNMMI Research

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Electronic): 2191-219X

Publication date (Electronic): 8 April 2020

Publication date PMC-release: 8 April 2020

Publication date Collection: 2020

Volume: 10

Electronic Location Identifier: 31

Affiliations

[1 ]GRID grid.27530.33, ISNI 0000 0004 0646 7349, Department of Nuclear Medicine and Clinical Cancer Research Center, , Aalborg University Hospital, ; Hobrovej 18-22, Postboks 365, DK-9100 Aalborg, Denmark

[2 ]GRID grid.5117.2, ISNI 0000 0001 0742 471X, Department of Clinical Medicine, , Aalborg University, ; Aalborg, Denmark

[3 ]GRID grid.5734.5, ISNI 0000 0001 0726 5157, Department of Nuclear Medicine, Bern University Hospital, , University of Bern, ; Bern, Switzerland

[4 ]GRID grid.452681.c, ISNI 0000 0004 0639 1735, Department of Nuclear Medicine, , Regional Hospital West Jutland, ; Herning, Denmark

Author information

Helle D. Zacho https://orcid.org/0000-0001-9089-288X

Article

Publisher ID: 618

DOI: 10.1186/s13550-020-00618-0

PMC ID: 7142208

PubMed ID: 32270300

SO-VID: a6eb53f4-8bd2-4f01-8d4b-fc2ef6c5fc3e

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 15 January 2020

Date accepted : 19 March 2020

Funding

Funded by: Aase og Ejnar Danielsens Fond (DK)

Funded by: Det Obelske Familiefond (DK)

Custom metadata

ScienceOpen disciplines: Radiology & Imaging

Keywords: psma pet/ct,bone scintigraphy,bone scan,bone metastases,newly diagnosed prostate cancer

Data availability:

ScienceOpen disciplines: Radiology & Imaging

Keywords: psma pet/ct, bone scintigraphy, bone scan, bone metastases, newly diagnosed prostate cancer